Abstract
The purpose of the current study was to explore the reactions of Native American adolescents to participating in survey research on sexual and dating violence. Participants were 149 Native American adolescents who completed a survey in school. Survey items included sexual assault, dating violence, sexual harassment, and demographic questions. At the end of the survey, participants were asked if they were upset by the survey. Results showed that almost a quarter of youth were upset by the survey (24.2%), victims were more likely than non-victims to be upset by the survey, perpetrators were more likely than non-perpetrators to be upset by the survey, and sexual minorities were more likely than non-sexual minorities to be upset by the survey. Sex and age did not emerge as significantly associated with being upset. Participants were asked to describe why they were upset, and a content analysis revealed four categories of responses (i.e., feeling awkward or weird, topic of the survey, reminders, and “other”). Overall, although the research was well tolerated by most of the participants, researchers should consider adding information about what might increase feelings of upset in parental consent and youth assent forms, such as being reminded of a past upsetting experience and/or feeling awkward or weird because of some of the questions.
Sexual and related forms of violence (e.g., dating violence, sexual harassment) among adolescents is a serious public health issue. Research suggests that racial and ethnic minority youth, including Native American adolescents, experience higher rates of sexual and dating violence than White youth (Eaton & Stephens, 2018; Hautala et al., 2017; Rosay, 2016; Rutman et al., 2008). However, little research has focused on sexual and dating violence among minority adolescents particularly those from historically marginalized groups like Native Americans. Engaging Native American adolescents in research is critical to better understanding the rates, correlates, and outcomes associated with sexual and dating violence among this population in order to inform culturally grounded prevention and intervention initiatives.
However, there are challenges associated with conducting this type of research. Native Americans hold mistrust and skepticism of the scientific community grounded in repeated, well-documented examples of unethical medical and clinical research misconduct wherein researchers have failed to obtain informed consent, withheld pertinent information relative to study procedures, and neglected to follow-up as planned after data are collected (Crump et al., 2020; Pacheco et al., 2013). To gain control over outside researchers, tribal governments have established Tribal Institutional Review Boards (IRBs) and many require that outside researchers give back to the community (e.g., community reports, presentations, data files; Hodge et al., 2000). There is also growing recognition of the importance of community-engaged research in which community members partner with researchers throughout all stages of the research, helping to ensure that research is conducted ethnically with Native Americans (Thomas et al., 2011). Furthermore, IRBs sometimes express concern about asking participants to disclose traumatic events, including victimization experiences, with the fear that participation will cause participants to be upset or even distressed (Jaffe et al., 2015). In response, there is a growing body of research exploring participants’ reactions to engagement in research studies that examine sensitive topics, like sexual and dating violence (Jaffe et al., 2015; McClinton Appollis et al., 2015). However, no research to date has examined the reactions of Native American adolescents to participating in sexual and dating violence research.
In general, research suggests that asking participants about potentially traumatic experiences, including victimization, leads to low to moderate levels of upset in participants and that being upset is generally minimal and transient (Carlson et al., 2002; Jaffe et al., 2015; Legerski & Bunnell, 2010; Newman & Kaloupek, 2009). Furthermore, some researchers have argued that experiencing negative emotions following the completion of a survey is not necessarily a drawback to research as these types of feelings may serve as cues to participants that there are unresolved issues (e.g., being in an abusive relationship) that need to be addressed (Edwards et al., 2014). What is more, many participants reported positive experiences associated with their research participation, even if initially some of them were upset (Carlson et al., 2002; Edwards et al., 2016; Jaffe et al., 2015). For example, in a sample of predominantly White high school students that focused on dating and sexual violence, researchers found that 2% of adolescents regretted participating in the study, 6% were upset by the study questions, and 49% reported that they personally benefitted from being in the study (Edwards et al., 2016). Although similar findings have been documented in other samples of adolescents (Jaffe et al., 2015), research has not focused on the experiences of Native American adolescents who have participated in sexual and dating violence research.
In addition to documenting the extent to which participants are upset by participating in sexual and dating violence research, several studies have examined reasons for being upset. Although most of this research has focused on quantitative correlates of being upset, a handful of studies have directly asked participants what specifically about the research procedures was upsetting to them (Edwards et al., 2017; Edwards et al., 2020). In general, research suggests that individuals who report sexual and dating violence experiences, including both victimization and perpetration, are more likely to report being upset than individuals who do not report sexual and dating violence experiences (Edwards et al., 2012; Edwards et al., 2016; Edwards et al., 2017; Jaffe et al., 2015). Of note, very few studies have focused on reactions to answering question about perpetration experiences (Edwards et al., 2012), and none among high school youth to our knowledge. In open-ended questions about reasons for being upset by dating and sexual violence questions, adolescents and young adults have reported the following: not liking to think about sexual and dating violence in general, not liking to think about personal experiences with sexual and dating violence, feeling that the questions were too personal, and/or being upset about their peers’ reactions to the research (e.g., laughing, not taking it seriously; Edwards et al., 2016; Edwards et al., 2017).
Additionally, some research has examined demographic correlates of reactions to research. For example, researchers have documented that girls experience more negative reactions to research than boys, although this research is somewhat equivocal (McClinton Appollis et al., 2015) and that older adolescents are more likely to experience research-related upset than younger adolescents (Edwards et al., 2016), a finding that is also mixed (Ybarra et al., 2009). These divergent findings reinforce the need to examine research reactions in samples that include older and younger adolescents. Relative to sexual minority adolescents, research on emerging adults finds that respondents belonging to sexual minority groups had similar levels of being upset when compared to heterosexual respondents (Kuyper et al., 2010), while other research has found that sexual minorities report more negative thoughts and express more of a need for help as a result of research participation (Kuyper & Bos, 2017). We are not aware of any research that has examined if sexual minority adolescents differ from heterosexual adolescents on their reactions to sexual and dating violence research. However, given that sexual minority adolescents report higher rates of sexual and dating violence compared to heterosexual adolescents (Edwards et al., 2015), it is possible that they may also be more likely to report being upset by questions that ask about sexual and dating violence compared to heterosexual adolescents.
The purpose of the current study was to examine how Native American middle and high school youth felt about participating in sexual and dating violence research. Specific aims are as follows:
Assess the frequency of being upset by engaging in survey research. Based on prior research findings, we anticipate that most participants would report that they were not upset by the survey research. Assess the correlates of being upset by engaging in survey research. Based on prior research findings, we anticipate that adolescents with sexual and dating violence experiences would be more likely to report being upset than youth without sexual and dating violence experiences. We further hypothesized that sexual minority youth, female-identified youth, and older youth would be more likely to report being upset by the survey. Elucidate adolescent’s reasons for being upset about engaging in research. Based on prior research findings, we anticipate that reasons for being upset would be related to reminders about upsetting experiences and discomfort with the questions more broadly.
Method
Research Design and Setting
These data are part of a pilot non-randomized clinical trial to evaluate a rape prevention program on an Indian reservation in the Great Plains region of the United States. Data for this study come from 6th through 12th-grade students from three schools on a rural Indian reservation. Prior to the start of the study, we obtained University IRB approval, Tribal IRB approval, and Tribal Council approval (via a Tribal Resolution). The President of the Tribe approved the publication of this article. Community members provided input on various phases of the project (e.g., measurement selection, data analysis, and interpretation).
Participants
Participants were 149 1 Native American adolescents in grades 6th through 12th living on an Indian reservation. A little over half the participants (52.7%, n = 78) were 15 years of age or older and roughly 61.5% (n = 91) identified as female. Almost a third of participants identified as heterosexual (65.8%, n = 98); however, it should be noted that a large proportion of the sample did not answer the sexual orientation item (13.4%, n = 20). A little more than half of the sample were high school students (n = 79; 53.0%). Based on Census data, between 62.2% and 77.4% of households on the reservation with children lived below the poverty line at the time of the study (U.S. Census Bureau, 2018). Thus, most of the sample lived in poverty. Participants who did not answer the item about being upset were not significantly different than those who did answer the item in terms of victimization, perpetration, sex, or sexual identity.
Procedures
Active guardian consent procedures were used for participants under 18 years of age. We invited all students in grades 6 to 12 (n = 1,103) at the beginning of the fall 2018 semester to enroll in the study; the data for the current study were collected in the spring and fall of 2019. Intensive recruitment procedures were utilized to acquire guardian consent (e.g., mailings, school-distributed forms, calling households in which consent forms had not been returned). We also had multiple ways in which guardians could return the consent forms (e.g., via email, text message, in-person). Returned consent forms represented 35.7% (n = 394) of eligible participants and 86.5% (n = 341) of eligible participants were given permission by their guardian to take the survey. Over half of the students with guardian permission took the survey (56.0%; N = 191). From this group, only respondents who identified as Native American (N = 184) and who answered the item about being upset (n = 149) were included in the current study. Gift card drawings were used to incentivize returning the consent form regardless of whether youth were allowed to participate. The survey was administered on computers or via paper in school by trained research staff. Participants received a small incentive (e.g., fruit snack, pencil) and were entered to win a $100 gift card or cash for participating in the survey. Participants were allowed to skip questions and still received the incentive. The individuals who administered the surveys represented various racial/ethnic backgrounds, including Native Americans.
Measures
Upset.
Modeled after previous research (Edwards et al., 2016), upset was assessed by asking: “Did anything we asked you about today make you feel upset.” The “yes” responses were coded as 1, the “no” responses were coded as zero, and the “I don’t want to answer” responses were coded as missing. If participants responded with a yes, that something made them feel upset, they were asked to answer an open-ended question inquiring about what made them upset.
Victimization and Perpetration
Several measures were used to assess interpersonal violence victimization and perpetration experiences during the past six months, all with response options 1 = Yes or 0 = No. We used mirror items to assess for both victimization and perpetration experiences. Three items assessing sexual assault were drawn from Cook-Craig et al.’s (2014) including measures for sexual coercion (e.g., “You had sexual activities with someone because you either threatened to end your friendship or romantic relationship if they didn’t or because you pressured the other person by arguing or begging?”), physically forced sex (e.g., “You had sexual activities with someone by threatening to use or using physical force [twisting their arm, holding them down, etc.]?”), and incapacitated sex (e.g., “You had sexual activities with someone because she or he was drunk or on drugs?”). Three items from the Youth Risk Behavior Survey (YRBS) were used to assess physically forced sexual contact (e.g., “You forced someone to do sexual things that she or he did not want to do [count such things as kissing, touching, or physically forcing someone to have sexual intercourse]?”), sexual dating violence (e.g., “You forced someone you were dating or going out with to do sexual things that they did not want to do [count such things as kissing, touching, or physically forcing someone to have sexual intercourse]?”), and physical dating violence (e.g., “You physically hurt someone you were dating or going out with on purpose [count such things as hitting, slamming into something, or injuring them with an object or weapon]?”) (Centers for Disease Control and Prevention, 2014). These items have been shown to be valid and reliable indicators of sexual assault (Brener et al., 2002; Centers for Disease Control and Prevention, 2017; Eaton et al., 2012). Two items from the American Association of University Women (AAUW) were used to assess sexual harassment (i.e., sexual comments [e.g., “You made sexual comments, jokes, gestures, or looks about/to a person?”] and sexual rumors [e.g., “You spread sexual rumors about a person?”]) (AAUW, 2001). All the items were summed to create a total interpersonal violence victimization score and a total interpersonal violence perpetration score. The data were skewed because of low rates of endorsement. Therefore, the scores were recoded to be dichotomous (1 = Yes, in the past six months and 0 = No, not in the past six months).
Demographics
Several measures were included to gather participant’s demographic data. Specific questions inquired about sex (male = 0, female = 1) and sexual minority status (gay, lesbian, bisexual, or questioning = 1, non-sexual minority = 0). Age was coded as 0 = 14 or younger and 1 = 15 or older.
Analytic Strategy
Frequencies and mean scores for being upset and the independent variables of interest (i.e., victimization, perpetration, age, sex, and sexual minority) were assessed using STATA 13 (Aim 1). A series of chi-square tests were conducted to examine the association between being upset and the independent variables of interest (i.e., Aim 2). Finally, a content analysis, as outlined by Bauer (2000) was conducted to explore the reasons that adolescents gave for being upset as a result of participating in the research (Aim 3). For the content analysis, the first and second authors read through all the open-ended responses to obtain the gestalt of the data, identified all possible categories of responses, and finalized the coding scheme. After independently coding the responses using the finalized coding scheme, the first and second authors met again to compare the coded responses. Interrater agreement was high among raters (97.4%) and all disagreements were discussed until mutual agreement was reached.
Results
Aim 1: Frequency of Reactions to Research
Almost a quarter of respondents (24.2%) reported being upset by the survey. Relative to the independent variables of interest, 34.0% of participants who experienced victimization reported being upset by the survey, 54.6% of participants who reported perpetration reported being upset by the survey, 38.7% of sexual minorities reported being upset by the survey, a quarter of youth aged 14 or younger (25.7%) reported being upset by the survey, roughly 23.1% of youth 15 or older reported being upset survey, 23.1% of girls reported being upset by the survey, and 24.6% of boys reported being upset by the survey.
Aim 2: Correlates of Reactions to Research
Correlates of Reactions to Research.
Note. aA Fisher’s exact test was used because the chi-square test’s assumptions were violated (i.e., 25% of cells had expected frequencies lower than 5).
Aim 3: Reasons for Reactions to Research
Short Answer Response Results From the Reaction to Research Question.
Note. Percentages are the valid percentages among participants who responded to the question (n = 35).
Percentages may not total 100% due to missing responses or multiple themes that emerged from a single respondent.
Participants who gave no response are not included in the denominator.
Examples are depicted exactly as written by the participant.
Discussion
The purpose of this study was to assess the extent to which Native American adolescents report being upset by engaging in sexual and dating violence research. Overall, participating in the research appeared to be well tolerated with fewer than a quarter of participants reporting that they were upset by engaging in the research. However, the study did find a somewhat higher rate of being upset than other studies with youth (Edwards et al., 2016; McClinton Appollis et al., 2015). Research suggests that individuals with higher levels of depression have more negative reactions to research than individuals with lower levels of depression (Edwards et al., 2017). Although we did not measure depression in the current study, research suggests that Native American youth have higher rates of depression than White youth (Centers for Disease Control and Prevention, 2020). Higher rates of depression among this population may explain why a larger proportion of youth in the study reported being upset compared to youth in other studies (Centers for Disease Control and Prevention, 2020; Edwards et al., 2016; McClinton Appollis et al., 2015).
Moreover, victims and perpetrators were more likely to be upset than non-victims and non-perpetrators, respectively. This finding is consistent with previous research with White samples of youth (Edwards et al., 2016). Sexual minority youth were more likely to report being upset than non-sexual minority youth. While this finding is consistent with some prior research (Kuyper & Bos, 2017), it differs from the results of other studies that have found sexual minority and non-sexual minority adolescents to have similar reactions to research (Edwards & Sylaska, 2015; Kuyper et al., 2012). This finding does not appear to be related to victimization experiences as research examining the link between sexual identity and sexual and dating violence using the current sample did not find significantly higher rates of victimization among sexual minority girls (Edwards et al., 2021). Instead, perhaps it is related to other factors that were not measured in the current study like psychological distress and/or loneliness, both factors that have been linked to research-related upset (Kuyper & Bos, 2017). Ultimately, the data underscore the importance of examining variability in reactions to research as a function of multiple marginalized social identities in samples of Native American adolescents.
Sex did not emerge as a correlate of reactions to research. Perhaps this finding is a reflection of the fact that boys and girls in the population experience higher rates of adverse childhood experiences (Warne et al., 2017), a factor that was not controlled for in the current study but that could be linked to being upset by sexual and dating violence research. Additionally, age did not emerge as a correlate of reactions to research a finding that is consistent with some (Edwards et al., 2016) but not all research (Ybarra et al., 2009). Much more research is needed to understand how age impacts research-related upset. It is important to keep in mind that the majority of participants, however, were not upset by the survey questions.
Participants gave several reasons explaining why engaging in the research was upsetting. Respondents stated that it felt awkward or weird engaging in the research, that the topic of the survey and/or the overall nature of the study was upsetting, and that the research reminded them of something, perhaps past experiences of violence that may have not been thought about for a while. Several respondents gave other reasons for being upset such as having preexisting depression, thinking about it made them feel bad for other girls, or feeling upset because they did not know how to answer the questions. The themes that emerged out of the open-ended response are like responses seen in other studies examining reactions to research among adolescents (Edwards et al., 2016; Hasking et al., 2015). It is reassuring that the most common reason for being upset is related to feelings of awkwardness, which does not indicate high levels of distress. Moreover, although some participants reported that the questions reminded them of past upsetting experiences, likely those connected to victimization and/or perpetration, none of the youth wrote that they were highly distressed, regretted participating, and so forth. Moreover, during the administration of the surveys, no youth were visibly upset or distressed. Finally, it is important to remember that being upset is not necessarily an adverse thing as it may facilitate help-seeking and/or leaving an abusive relationship (Edwards et al., 2014).
Limitations
There are several limitations to the current study worth noting. The sample was relatively small and not necessarily generalizable to youth who did not participate. The analysis relied on self-report data and there was a good deal of missing data, both of which may have introduced bias into the study. There was an especially large amount of missing data on the sexual orientation question. This could be because youth did not understand the question and/or they were a sexual minority and did not wish to disclose this. Despite this missing data, sexual minority youth were more likely than heterosexual youth to report being upset by the survey. A larger portion of youth did not answer the survey item about being upset which may have introduced some bias. Specifically, youth who did not answer the item may have felt more upset than youth who did answer the item. Thus, a higher percentage of youth may have been upset by the study than what is reported herein. Relatedly, the cell sizes for some analyses were small and likely reduced power to detect significant effects, if they indeed exist. Also, only about half of the participants who endorsed being upset responded to the open-ended question making it impossible to ascertain whether other factors may have contributed to participant upset. In addition to using larger samples in future research, it could be useful to gather additional data as to why youth declined to answer questions.
Additional limitations include the fact that the victimization and perpetration indicators were also collapsed across verbal and physical violence because of the low rate of occurrence and the small sample size and thus the extent to which different types of victimization and perpetration experiences relate to reactions to research is unknown. Some victimization instruments, although widely used, lack validity information. We also used a single item indicator to gauge whether participants were upset as well as singular indicators from some of the correlates. Future research should consider more comprehensive measures when conducting similar studies. We also did not collect information on sex outside the male/female binary and therefore could not gauge the extent to which other groups were upset by the research. We also asked participants to disclose if they felt they benefitted from the research; however, we chose to exclude those responses in the current study because there appeared to be confusion about the interpretation of the question. Namely, some respondents thought that the question was inquiring about whether they felt they benefited from the programming instead of engaging in the research. We are confident that the responses to the upset item were for the research since many of the statements included words like the survey or the questions, and this question was asked prior to the benefit question. Finally, research is needed to determine how long youth report that being upset lasts. In research on distress after research participation, studies have found no long-term adverse impact of research participation (Jorm et al., 2007). Indeed, longitudinal research with college students finds that being upset usually passes within a short period of time (Edwards et al., 2013).
Implications
The current study has important implications for future research with Native American youth. Although the research was well tolerated by most of the participants, researchers could consider adding information about what might increase feelings of upset in parental consent and youth assent forms, such as being reminded of a past upsetting experience and/or feeling awkward or weird as a result of some to the questions. Reminding participants several times throughout the survey session that answering questions is optional and they can stop any time without penalty appears to be a good strategy and is something often done in research. Finally, similar to what we did in the current study, we urge researchers to partner with community members so that they are engaged in all phases of the research, which can help to ensure that research methods are both rigorous and acceptable. Despite the need for additional research, the findings of the current study show that research on sexual and dating violence is well tolerated among Native American adolescents, although it is important to make sure that steps are taken throughout the research process to ensure participants are aware of the topic and the discomfort they may experience as a result of engaging in the research. Research on these topics among Native American youth is critical to develop and evaluate culturally grounded prevention programs, with the ultimate goal of reducing dating and sexual violence and other health disparities among this population. What is more, given that some youth reported being upset by the survey, it is possible that these same youth could report being upset by prevention programming content that discusses similar topics. Prevention specialist should be mindful of this and ensure that youth understand that program participation is voluntary, trauma-informed, and culturally grounded.
Footnotes
Acknowledgments
We owe a great deal of gratitude to our school and community partners and project staff, including Lee Paiva, Linda Garriot, Janet Routzen, Nicole Collins, Sun Rise Black Bull, Skyler Hopfauf, and Brianna Simon. Without these individuals, this project would not have been possible.
Declaration of Conflicting Interests
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
